Design and Methods of a Synchronous Online Motivational Interviewing Intervention for Weight Management

A Health Belief Model-Based Motivational Interviewing for Medication Adherence and Treatment Success in Pulmonary Tuberculosis Patients

Medication adherence behavior plays a central role in the success of tuberculosis (TB) treatment. Conventional motivation is not optimal in strengthening long-term medication adherence. A motivational interviewing (MI) communication motivation model based on the Health Belief Model (HBM) was designed with the main objective of improving medication adherence and treatment success. This study used an experimental design with a randomized posttest-only control group design. The intervention and control groups consisted of 107 TB patients each, who were selected by random cluster sampling. The study was conducted from November 2020 to June 2021 at 38 public health centers in Bali Province. The HBM-based MI model intervention was given in seven counseling sessions, pill count percentages were used to measure medication adherence, and treatment success was based on sputum examination results. Logistic regression was used to assess the effect of the intervention on medication adherence and treatment success. Logistic regression analysis showed that MI-based HBM and knowledge were the most influential variables for increasing medication adherence and treatment success. Medication adherence was 4.5 times greater (ARR = 4.51, p = 0.018) and treatment success was 3.8 times greater (ARR = 3.81, p < 0.038) in the intervention group compared to the control group, while the secondary outcome of knowledge of other factors together influenced medication adherence and treatment success. The conclusion is that the HBM-based MI communication motivation model creates a patient-centered relationship by overcoming the triggers of treatment barriers originating from the HBM construct, effectively increasing medication adherence and treatment success for TB patients, and it needs further development by involving families in counseling for consistent self-efficacy of patients in long-term treatment.

Professional Master's Degree Students' Perceptions on the Changes Digitalisation Imposes on Counselling in the Social and Health Care Sector

The study portrays the social and health care master’s students’ (N = 19) perceptions on the changes in work practices due to digitalisation, with a special focus on online counselling. Furthermore, the data include thoughts on the impact digitalised interaction, i.e., online counselling, has on their work and professional identities. The students studied how the motivational interviewing method combined with a solution-focused counselling approach is applicable in online settings by using simulation pedagogy. The data consisted of students’ learning diaries. Furthermore, the data were analysed using inductive content analysis. The results show that the digitalisation of work practices demands blended professionalism, which allows the professional to work both face-to-face and online with clients. In addition, the education of social and health care professionals needs to address the lack of competences and skills in digitalised work practices and provide a conceptual and practical understanding of blended professionalism in the sector.

Motivational interviewing in eHealth and telehealth interventions for weight loss: A systematic review

The alarming prevalence of adult obesity warrants consideration of treatments with broad reach; digital health interventions meet this need and have demonstrated efficacy for weight loss. One approach that can be delivered remotely is motivational interviewing - a counseling style that helps resolve ambivalence to change unhealthy behavior. This is the first review to systematically examine eHealth and telehealth interventions that incorporate motivational interviewing for weight loss. We searched four electronic databases (PubMed, Embase, PsycInfo, CINAHL) for publications from November 2009-May 2018. Included papers were weight loss RCTs conducted among adults with overweight or obesity that examined eHealth or telehealth interventions with motivational interviewing, compared to any type of treatment arm without it. Results were presented separately by comparison arm (control vs. active comparator). Sixteen papers (15 trials) were included. Twelve used telephone-based counseling to deliver motivational interviewing, two used email and phone, and one used online chats. When compared to a no-treatment control arm, the motivational interviewing arm was associated with greater weight loss on 6 of 11 occasions, but performed better than an active comparator on only 1 of 7 occasions. Retention and engagement were generally high, though few trials examined the relation with weight loss. No trial had high risk of bias, but five lacked power calculations and only two reported fidelity to motivational interviewing. Telephone-based interventions that incorporate motivational interviewing hold promise as effective obesity treatments. There is a dearth of evidence to support the use of motivational interviewing via eHealth, signaling a needed research area.

The impact of the interventionist-participant relationship on treatment adherence and weight loss

Little is known about the impact of the relationship built between interventionists and their participants on weight loss. Our objective is to determine whether stronger early (i.e., 4 weeks) participant-interventionist bond is associated with significantly greater weight loss success and treatment adherence. Three hundred and ninety-eight participants received an online group behavioral weight control program over 18 months. Weight was measured objectively at baseline and at 6 and 18 months. At 4 weeks, participants completed the Working Alliance Inventory (WAI) bonding subscale, which measures the collaborative bond with the interventionist. Adherence (i.e., session attendance and online self-monitoring diary completion) was recorded by the interventionists. Participant-interventionist bond at 4 weeks was significantly associated with weight loss at 6 months (t(322) = -2.14, p = .03) but not at 18 months (t(290) = 0.53, p = .60). The model indicated that participant-interventionist bond at 4 weeks was a significant predictor of adherence at 6 months (b = .063, standard error [SE] = .30, p = .04), and 6 month adherence was a significant predictor of weight loss at 6 months (b = -.594, SE = .049, p < .0001). The indirect effect of the WAI-Bond subscale was significant (b = -.037, p = .03, 95% confidence interval: -.074, -.002) and accounted for 54% of the total effect of participant-interventionist bond on weight loss. However, the total weight loss explained by WAI-Bond subscale was small (0.04 kg). Participant-interventionist bond between participant and interventionist is an early predictor of treatment adherence and weight loss success at 6 months; however, the degree of weight loss explained by participant-interventionist bond is small and was not maintained at 18 months.

Log Often, Lose More: Electronic Dietary Self-Monitoring for Weight Loss

OBJECTIVE

Dietary self-monitoring is consistently related to both short- and long-term weight loss. The purpose of this study was to quantify the time spent and the daily frequency of self-monitoring necessary for weight-loss success.

METHODS

Participants in a 24-week, online, behavioral weight-control intervention recorded daily dietary intake using a Web-based dietary analysis program. Time spent self-monitoring and frequency of dietary journal page access were captured. Weight loss (kilograms) and the proportion of participants losing ≥ 5% and ≥ 10% of baseline weight were assessed at 6 months.

RESULTS

Participants (n = 142; BMI 35.8 kg/m² ; 90.8% female; 23.2% African American) spent an average of 23.2 minutes per day self-monitoring in month 1 and 14.6 minutes in month 6. For those still recording any minutes self-monitoring by month 6 (65.5%), there were no significant differences in time spent based on weight loss; however, those losing either ≥ 5% or ≥ 10% logged in to the journal Web page significantly more times per day (1.6 vs. 2.4, P < 0.001 for < 5% vs. ≥ 5%; 1.7 vs. 2.7, P < 0.001 for < 10% vs. ≥ 10%).

CONCLUSIONS

The frequency of self-monitoring is significantly related to weight loss, with the time needed to be successful diminishing during the intervention.

Tele-Motivational Interviewing for Cancer Survivors: Feasibility, Preliminary Efficacy, and Lessons Learned

OBJECTIVE

Determine the feasibility, acceptability, and efficacy of tele-Motivational Interviewing (MI) for overweight cancer survivors.

DESIGN

Six-month nonrandomized phase 2 clinical trial.

SETTING

Urban garden and remote platforms.

PARTICIPANTS

Overweight and obese cancer survivors post active treatment.

INTERVENTION

Remote tele-MI from a trained registered dietitian nutritionist (RDN).

MAIN OUTCOME MEASURES

Feasibility, acceptability, and preliminary efficacy.

ANALYSIS

Groups were stratified as users and nonusers based on tele-MI use. Qualitative survey data and remote MI interaction logs were analyzed for trends. Two-sample t tests were performed to assess pre-post intervention changes in physical activity and dietary behaviors, quality of life, self-efficacy, and clinical biomarkers.

RESULTS

A total of 29 participants completed the intervention. There were 17 tele-MI users (59%) and 12 nonusers (41%). Users were primarily female (88%), breast cancer survivors (59%), college educated (82%), with a mean age of 58 years. Users set 50% more goals, lost more weight (4.8 vs 2.6 kg), significantly improved quality of life (P = .03), and trended more positively in clinical biomarkers (eg, cholesterol, blood pressure) than did nonusers.

CONCLUSIONS AND IMPLICATIONS

Findings from this study indicate that tele-MI is a feasible and acceptable intervention for overweight cancer survivors after active therapy. Larger randomized trials are needed to establish efficacy and generalizability to a variety of demographic populations.

Weight Loss Success of Participants Residing in Rural and Urban Areas

PURPOSE

Rural residents are significantly more likely to be overweight and obese than are urban residents. However, few data have compared weight control program responses in these population groups. Therefore, the primary aim of this study was to evaluate the weight loss outcomes of participants in a multisite, online behavioral intervention by residential location (rural vs urban) and, second, assess any possible differences in adherence to treatment goals.

METHODS

A total of 492 adult participants (mean BMI = 35.7 kg/m² ; 90% female; 24% minority) were categorized based on their home ZIP code and the 2010 US Census Urban and Rural Classification criteria (58.3% rural; 41.7% urban). Weight (kg) was measured in-person at baseline and 6 months after participating in a behavioral weight control intervention. Adherence to physical activity and calorie and fat intake goals was assessed based on weekly self-monitoring journals. Weekly online chat attendance and completion of weekly online self-monitoring journals were recorded. Presence of obesogenic foods in the home was self-reported at baseline and 6 months.

FINDINGS

There were no statistically significant differences in weight loss between rural and urban participants (-6.1 kg vs -5.3 kg, P = .16), nor were there differences in chat attendance, self-monitoring journals, self-reported physical activity, calorie intake, or obesogenic foods reported in the household.

CONCLUSIONS

Overall, there was no difference in weight loss and adherence to treatment goals for rural and urban participants. Further research on rural and urban residents is necessary to explore the factors responsible for the disparity in obesity prevalence.

Favorable effects of motivational interviewing and support in a patient with schizophrenia and alcohol abuse

A 42‐year‐old man with schizophrenia was referred to our hospital after 2 weeks of worsening fatigue. His hemoglobin level was 2.8 g/dL owing to folic acid deficiency stemming from alcohol abuse and consumption of unbalanced meals. We induced behavioral changes in the patient by motivational interviewing. We had direct methodical conversations with medical staff involved with the patient as well as his family, and established new social support for him as well as public assistance. These have resulted in the patient maintaining a favorable lifestyle ever since.

Do individual, online motivational interviewing chat sessions enhance weight loss in a group-based, online weight control program?

OBJECTIVE

To examine whether the addition of online motivational interviewing (MI) chats to a Web-based, group behavioral obesity treatment program augments weight loss outcomes relative to the Web-based weight control program alone.

METHODS

Healthy individuals (N = 398, 24% minority) with overweight/obesity were randomized to a 36-session group Internet behavioral weight control treatment (BT) or the same group Internet treatment plus six individual MI chat sessions (BT + MI). Both conditions received weekly synchronous online chat group sessions for 6 months followed by 12 monthly group chats. Participants in both groups received identical behavioral lessons and individualized therapist feedback on progress toward meeting exercise and calorie goals. BT + MI also received six individual MI sessions delivered by a separate MI counselor via Web chat. Weight loss was measured at 6 and 18 months.

RESULTS

There were no significant differences in weight loss between BT (-5.5 ± 6.0 kg) and BT + MI (-5.1 ± 6.3 kg) at 6 months or at 18 months (-3.3 ± 7.1 kg vs. -3.5 ± 7.7 kg for BT and BT + MI, respectively). Attendance at group chats did not differ between groups, nor did self-monitoring patterns, suggesting comparable engagement in the weight control program in both conditions.

CONCLUSIONS

Online MI chat sessions were not a viable strategy to enhance Web-based weight control treatment outcomes.

Perspectives in obesity and pregnancy

Obesity is currently recognized as a health epidemic worldwide. Its prevalence has doubled in the last three decades. Obesity is a complex clinical picture associated with physical, physiologic, hormonal, genetic, cultural, socioeconomic and environmental factors. The rate of obesity is also increasing in the pregnant women population. Maternal obesity is associated with less than optimal obstetrical, fetal and neonatal outcomes. It is also associated with significant adverse long-term effects on both obese parturients and the infants born from obese women. A number of guidelines have been published to educate health care workers and the general population in an attempt to develop effective interventions on a large scale to prevent obesity. These guidelines are multiple, confusing and inconsistent. There are no standard recommendations regarding gestational weight gaining goals, nutrients and additional elements necessary for certain obese women who have been treated with bariatric surgical procedures, screening for metabolic diseases such as diabetes, additional preventive health care services indicated for obese women in the pregnancy planning stages, during prenatal care, in the immediate post-partum period and as a long-term approach for health preservation. In 2013, the American Medical Association supported by several US national medical specialty organizations published Resolution 420 (A-13) recognizing obesity as a disease state with multiple pathophysiological aspects requiring a range of interventions to improve its prevention and treatment. The goal of this decision was to encourage a broader spectrum of health care benefits insurance coverage for the prevention and treatment of obesity. There are a number of myths and misconceptions associated with obesity. These perspectives present our views and clinical experience with a partial review of recent bibliography addressing the associations between obese reproductive age women and their risks during pregnancy.